Download Incarcerated Umbilical Hernia Repair

Strattice™ Reconstructive Tissue Matrix Perforated Clinical Case Study
Incarcerated Umbilical Hernia Repair
Performed by Dr. Sean Orenstein, MD
Assistant Professor of Surgery
Oregon Health & Science University, Portland, Oregon
Patient History
A 62-year-old male with super morbid obesity (Class III) presented with a large incarcerated
primary umbilical hernia. Besides obesity, he has numerous comorbidities including obstructive
sleep apnea, COPD, history of CVA, DVT/PE, stage 3 CKD, type 2 diabetes mellitus, hyperlipidemia, peripheral edema, GERD, depression as well as chronic pain. He was prescribed
multiple medications including warfarin, aspirin, furosemide, oxycodone, as well as others,
though he has been off insulin and only on oral hypoglycemic agents after losing over 100
lbs. with diet and exercise.
Materials and
Methods
Incarcerated Umbilical Hernia Repair – Strattice Reconstructive
Tissue Matrix Perforated
Strattice Reconstructive Tissue Matrix (TM) Perforated was selected due to tissue ingrowth
properties as part of the hernia repair strategy for a patient at high risk for postoperative
wound complications, most notably his super morbid obesity and diabetes. At time of
operation (Figure 1), the hernia defect measured 9cm wide x 10cm in length (Figure 2),
and a retrorectus hernia repair was performed. The hernia was characterized by a large
amount of incarcerated omentum along with healthy small bowel without signs of bowel
ischemia or obstruction (Figure 3). There was some necrotic omentum present which
was excised. The hernia repair strategy included placement of a single piece of 20cm x
25cm Strattice TM Perforated in the retrorectus plane (Figure 4). The posterior sheath was
closed with running slowly resorbable sutures. The Strattice TM Perforated was fixated
with multiple transfascial resorbable sutures. Two 19-Fr Blake drains were placed in the
retrorectus plane above the mesh, below the anterior sheath. The anterior fascia was
closed with running slowly resorbable sutures. Skin was closed in layers with resorbable
sutures and covered with dermal adhesive (Figure 5).
Postoperative
Course/Results
After surgery, the patient was admitted to a ward bed on continuous pulse oximetry.
On postoperative day (POD) 1, the patient was given clear liquids, and was advanced
to a regular diet on POD 2. Bowel function returned by POD 3. A multimodal pain control
strategy was utilized with IV and oral medications and transitioned to all oral medications
on POD 3. Prophylactic anticoagulation was instituted on POD 0, then transitioned
to warfarin on POD 1 and therapeutic LMWH on POD 3.
Strattice™ Reconstructive Tissue Matrix Perforated Clinical Case Study
Postoperative
Course/Results
(continued)
One of the two drains was removed on POD 3 due to reduced output (10mL/24 hrs),
and the patient was discharged with one remaining drain on POD 4. No in-hospital
complications were observed at time of discharge.
The patient developed mild abdominal wall cellulitis around POD 14 and was treated by
his local physician with one dose of IV antibiotics (ceftriaxone) along with an oral antibiotic
regimen (doxycycline). At his scheduled postoperative visit POD 21, there were no further
signs of cellulitis, and there was no indication of seroma, surgical site infection nor hernia
recurrence. The patient reported that he was feeling quite well and only experienced
mild pain. The second drain was removed, after reporting 10-20 mL output per day.
Fig. 1
Fig. 2
Fig. 4
Fig. 5
Fig. 3
This clinical case is based upon the clinical experience of Sean Orenstein, MD. Results may not be typical and individual results
may vary. Users should read and understand all Instructions for Use, including safety information, prior to application of the
product. The images contained in this case study are courtesy of Sean Orenstein, MD.
Before use, physicians should review all risk information, which can be found in the Instructions for Use attached to the packaging
of each Strattice Tissue Matrix graft. Rx only.
CONTRAINDICATIONS: Strattice is derived from a porcine source and should not be used in patients with known sensitivity to
porcine material, or in patients with a known sensitivity to Polysorbate 20.
LifeCell Corporation
One Millennium Way
Branchburg, NJ 08876
Tel: 908.947.1100
Fax: 908.947.1200
www.lifecell.com
LifeCell Customer Solutions
800.367.5737
LifeCell Reimbursement Hotline
888.543.3656
[email protected]
© 2016 LifeCell Corporation, an Acelity Company. All rights reserved. Strattice™ is a trademark of LifeCell Corporation. All other trademarks are the properties of their respective owners. MLC4845/5362/2-2016